Under-five Child Mortality Research Articles

Preventing and Controlling Pneumonia among Under-Five Children: A Qualitative Study of Civil Society Organizations’ Roles in West Java and East Nusa Tenggara

BACKGROUND: Pneumonia is the leading cause of under-five children mortality in the world, including in Indonesia. Various programs were developed both nationally and internationally to overcome this disease. One of the programs is cross-sectorial collaboration and community involvement as part of pneumonia prevention and control programs, including the involvement of civil society organizations (CSO). However, the limited research has explored through the role of CSO in this program. AIM: This study aimed to explore the roles of CSO in preventing and controlling the childhood pneumonia. METHODS: This qualitative descriptive study interviewed 15 participants who were representatives of CSO in West Java and East Nusa Tenggara. These CSO have focused on health activities programs. In-depth interviews were conducted using semi-structured interview guides. Data were analyzed using the comparative analysis technique for qualitative descriptive research. RESULTS: Three main themes have been found from the data analysis, including community empowerment and integrated actions to prevent childhood pneumonia, providing pneumonia services and advocacies to overcome childhood pneumonia, and the expectation versus challenges of CSO. The three themes showed that CSO have significant roles in various aspects of the prevention and control programs of under-five pneumonia. CONCLUSION: Various roles have been done by CSO. However, several functions were not performed optimally. Further research that was analyzing factors the influence CSO’s roles is needed as fundamental information to develop strategies in improving the functions of civil society organizations in childhood pneumonia.

Gender Differences in Child Malnutrition in Ethiopia: Evidence from Three Decomposition Techniques

Ethiopia has one of the highest under-five child mortality rate in the world, which is higher for boys than for girls. Malnutrition is a major contributing factor to child mortality and that is why we assess the differences in child malnutrition status of boys and girls. Specifically, we study the extent to which the gender differences in malnutrition are associated with observable factors and socio-economic characteristics and to what extent these differences are unexplained and attributable to factors such as latent parental preferences, societal biases, and other unobservable factors. We use data from the Ethiopia Demographic and Health Survey and evaluate three anthropometric status measures – wasting, stunting, and being underweight. We utilize a reduced-form demand for nutrition framework and several decomposition techniques: Oaxaca-Blinder decomposition for non-linear models, Machado-Mata quantile decomposition, and the recentered influence function. The results indicate that measurable socioeconomic and locational characteristics have significant and plausible associations with malnutrition by gender. We also find that 3% to 4% of the difference in the anthropometric status may be attributable to unobservable factors that may include implicit parental preferences. This approach is useful in evaluating gender differences in other human capital development outcomes such as health and education, as well as those in malnutrition.

1155Effect of household air pollution on infant and child-mortality in Myanmar

Abstract Background Household air pollution (HAP) from solid fuel use (SFU) for cooking has been considered as a public health threat, particularly for women and children in low and middle-income countries (LMICs), with limited evidence. Hence, this study investigated the effects of HAP on neonatal, infant, and under-five child mortality in Myanmar. Methods The cross-sectional study employed data from the Myanmar Demographic and Health Survey (MDHS), the first nationally representative survey conducted in 2016. The sample consists of 3249 ever-married mothers with under-five children in the household with a 98% response rate. HAP (coal and biomass), and level of exposure to HAP (no exposure, moderate and high exposure) were exposures. Outcomes were self-reported neonatal, infant, and under-five mortality. Results The prevalence of SFU was 79.0%. The neonatal, infant, and the under-five mortality rates were 26, 45, and 49 per 1,000 live births, respectively. The odds of infant (aOR 2.17, 95% CI: 1.21, 3.88) and under-five child (aOR 2.22, 95% CI: 1.24, 3.95) mortality were higher in households with SFU compared with clean fuel use. When applying an augmented measure of exposure to HAP by incorporating both SFU and the kitchen’s location, the likelihoods of infant and under-five mortality were even higher among moderate and highly exposed children compared with unexposed children with similar trends. Conclusion Infants and under-five children are at higher risk of mortality from exposure to HAP. Key messages Increasing access to cookstoves and clean fuels is imperative to reduce the risk of infants and under-five child mortality in LMICs, including Myanmar.

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

ObjectiveTo assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.DesignA nationally representative cross-sectional survey.SettingThis study used data from the Ethiopia Demographic and Health...

Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under-five mortality in low- and middle-income countries.

Children are vulnerable to exposure of secondhand smoking (SHS) which is a major preventable cause of disease and death. This study aimed to investigate the association between parental tobacco use or SHS exposure, respectively, and under-five mortality. Data were obtained from the nationally representative and population-based Demographic and Health Surveys in low- and middle-income countries (LMICs) between 2000 and 2018. Cox proportional hazard regression models with complex survey design were conducted to examine the adjusted associations between parental smoking and SHS exposure and child under-five mortality. In the pooled analysis of parental smoking, 437322 children were included. Compared with children whose parents are not smoking, those whose father or both parents smoked any form of tobacco had higher risks of mortality (hazard ratio [HR]=1.08, 95% confidence interval [CI]=1.03-1.13; HR=1.18, 95% CI=1.06-1.32, respectively). In addition, parental using smokeless tobacco, smoking tobacco, and using smokeless tobacco and smoking tobacco simultaneously was significantly associated with child under-five mortality (HR=1.07, 95% CI=1.01-1.12; HR=1.12, 95%CI=1.04-1.21; and HR=1.17, 95%CI=1.06-1.30, respectively). In the pooled analysis of SHS exposure, 605442 children were included, and weekly and daily SHS exposure were significantly associated with child under-five mortality (HR=1.11, 95% CI=1.03-1.20, and HR=1.10, 95% CI=1.06-1.15, respectively). The results were robust in most stratification analyses and sensitivity analyses. Parental tobacco use and indoor SHS exposure were associated with increased risk of under-five mortality in LMICs. Comprehensive tobacco control programs should be considered by policymakers in LMICs to promote smoke-free environments for children.

Association between household air pollution and child mortality in Myanmar using a multilevel mixed-effects Poisson regression with robust variance

Household air pollution (HAP) from solid fuel use (SFU) for cooking is a major public health threat for women and children in low and middle-income countries. This study investigated the associations between HAP and neonatal, infant, and under-five child mortality in Myanmar. The study consisted of 3249 sample of under-five children in the households from the first Myanmar Demographic and Health Survey 2016. Fuel types and levels of exposure to SFU (no, moderate and high) were proxies for HAP. We estimated covariate-adjusted relative risks (aRR) of neonatal, infant, and under-five child mortality with 95% confidence intervals, accounting for the survey design. The prevalence of SFU was 79.0%. The neonatal, infant, and under-five child mortality rates were 26, 45, and 49 per 1000 live births, respectively. The risks of infant (aRR 2.02; 95% CI 1.01–4.05; p-value = 0.048) and under-five mortality (aRR 2.16; 95% CI 1.07–4.36; p-value = 0.031), but not neonatal mortality, were higher among children from households with SFU compared to children from households using clean fuel. Likewise, children highly exposed to HAP had higher risks of mortality than unexposed children. HAP increases the risks of infant and under-five child mortality in Myanmar, which could be reduced by increasing access to clean cookstoves and fuels.

MODELLING THE DETERMINANTS OF UNDER-FIVE CHILD MORTALITY RATES USING COX PROPORTIONAL HAZARDS REGRESSION MODEL

An under-five childhood mortality rates in Nigeria is still high, despite efforts of government at all levels to combat the menace. This study examined some factors that significantly affect under-five child mortality. A sample of mothers with children under the age of five from Nigeria Demographic and Health Survey data (NDHS, 2013 & 2018) was used to assess the effect of some selected predictor variables (or covariates) on childhood survival. Cox proportional hazards model is essentially a regression model popularly used for investigating the association between the survival time and one or more predictor variables. The results from final fitted Cox proportional hazards regression model that the covariates, contraceptive used by the mother, state of residence, birth weight of child and type of toilet facility used by the h-ousehold were found to be significantly associated with under-five survival in the North Central Region of Nigeria. All the calculations are performed using the R software for statistical analysis.

Using geographically weighted regression analysis to cluster under-nutrition and its predictors among under-five children in Ethiopia: Evidence from demographic and health survey.

Malnutrition among under-five children is a common public health problem and it is one of the main cause for the mortality of under-five children in developing countries, including Ethiopia. Therefore, lack of evidence about geographic heterogeneity and predictors of under-nutrition hinders for evidence-based decision-making process for the prevention and control programs of under-nutrition in Ethiopia. Thus, this study aimed to address this gap. The data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2016. A total of 9,384 under-five children nested in 645 clusters were included with a stratified two-stage cluster sampling. ArcGIS version 10.5 software was used for global, local and ordinary least square analysis and mapping. The spatial autocorrelation (Global Moran's I) statistic was held in order to assess the pattern of wasting, stunting, and underweight whether it was dispersed, clustered, or randomly distributed. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of under-nutrition indicators through SaTScan version 9.6 software. Geographically weighted regression (GWR) version 4.0 software was used to model spatial relationships in the GWR analysis. Finally, a statistical decision was made at p-value<0.05 with 95%CI for ordinary least square analysis and geographically weighted regression. Childhood under-nutrition showed geographical variations at zonal levels in Ethiopia. Accordingly, Somali region (Afder, Gode, Korahe, Warder Zones), Afar region (Zone 2), Tigray region (Southern Zone), and Amhara region (Waghmira Zones) for wasting, Amhara region (West Gojam, Awi, South Gondar, and Waghmira Zones) for stunting and Amhara region (South Wollo, North Wollo, Awi, South Gondar, and Waghmira zones), Afar region (Zone 2), Tigray region (Eastern Zone, North Western Zone, Central Zone, Southern Zone, and Mekele Special Zones), and Benshangul region (Metekel and Assosa Zones) for underweight were detected as hot spot (high risk) regions. In GWR analysis, had unimproved toilet facility for stunting, wasting and underweight, father had primary education for stunting and wasting, father had secondary education for stunting and underweight, mothers age 35-49 years for wasting and underweight, having female children for stunting, having children eight and above for wasting, and mother had primary education for underweight were significant predictors at (p<0.001). Our study showed that the spatial distribution of under-nutrition was clustered and high-risk areas were identified in all forms of under-nutrition indicators. Predictors of under-nutrition were identified in all forms of under-nutrition indicators. Thus, geographic-based nutritional interventions mainly mobilizing additional resources could be held to reduce the burden of childhood under-nutrition in hot spot areas. In addition, improving sanitation and hygiene practice, improving the life style of the community, and promotion of parent education in the identified hot spot zones for under-nutrition should be more emphasized.

Experiences of Clinic Managers Implementing the Integrated Management of Childhood Illness (IMCI) in Limpopo Province South Africa

ABSTRACT Integrated management of childhood illness (IMCI) strategy was developed for reduction of underfive child mortality. The strategy’s implementation is still inadequate even among trained professional nurses in the presence of clinic managers. A qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of clinic managers regarding the implementation of the IMCI strategy in Primary health care (PHC) clinics of Limpopo province, South Africa. Semi-structured individual interviews were used to collect data from sixteen (16) purposively selected clinic managers with more than three years of clinic management experience. The seven steps of Collaizi were used to analyse data. Trustworthiness was ensured throughout the study. Positively, managers experienced IMCI as a good strategy which improved nurses’ skills and knowledge, whilst the negative experiences included staff barriers, management barriers and lack of resources that need interventions. Clinic managers to strengthen and prioritise IMCI programme implementation.

The Magnitude of Wasting and Associated Factors among Children Aged 2-5 Years in Southern Ethiopia: A Cross-Sectional Study.

Background Malnutrition accounts for almost half of the global under-five child mortality. Worm infections are one of the immediate and commonest causes that affect the nutritional status of children. There is limited data related to the magnitude of wasting and associated factors among children. Therefore, this study was aimed at assessing the magnitude of wasting and associated factors among children aged 2 to 5 years in the Wonago district of Gedeo Zone, southern Ethiopia. Methods Community-based cross-sectional study design was conducted. A total of 3324 children aged 2-5 years were included in the study. A pretested semistructured questionnaire was used for data collection, and anthropometric measurements were computed using the World Health Organization Anthro-nutritional software. The multivariate logistic regression analyses with adjusted odds ratio, 95% confidence interval, and P value less than 0.05 were used to identify the factors significantly associated with wasting. Results A total of 3273 children aged 2-5 years participated with a 98.5% response rate. The magnitude of wasting was 13%. The factors like government-employed fathers [AOR = 1.93; 95% CI (1.08, 3.46)], child's age range between 48 and 59 months [AOR = 1.46; 95% CI (1.01, 2.09)], being a male child [AOR = 1.42; 95% CI (1.07, 1.88)], having diarrheal disease in the past two weeks [AOR = 0.39; 95% CI (0.17, 0.90)], and bathing less than two times per week [AOR = 1.42; 95% CI (1.03, 1.96)] were factors significantly associated with wasting. Conclusion Undernutrition in children is still a problem, and the proportion of wasting was 13%. Government-employed fathers, child's age range between 48 and 59 months, being a male child, having diarrheal disease in the past two weeks, and bathing below two times per week were significantly associated with children's nutritional status warranting close attention by policymakers and stakeholders. For researchers, a further longitudinal study is recommended to get strong evidence.

Predictive Model on Determinants of Child Mortality Using Multiple Regression Analysis

Child mortality is one of the important factors to reflect sustainable development for any nation. It is common sense now that child mortality rate depends on medical services platform and its quality. To predict model under-five child mortality rates in India, multiple linear regression analysis was used. Identifying the factors that affects the under-five child mortality. To examine the relationship between all the variables along with recognize the problem of multicollinearity in the variables. In this study our fitted multiple linear regression model found that under five child mortality rates in India are influenced by tuberculosis case detection rate, measles death rate and hepatitis immunization rate. To choose appropriate model ACI score is used.

Correlates of Undeer Five Mortality in SNNPR Regional State, Spatial Data Analysis

The main aim of this study was to identify determinants of under-five child mortality, to describe spatial dependence of child mortality and develop models specifying risk factors used to diagnosis of child mortality among districts in SNNPR State of Ethiopia by using 2016 EDHS collected for 75 weredas/districts by employing spatial models. Spatial lag and spatial error model were fitted to the data, though spatial lag model specification was taken as the best fit for child mortality rate. Accordingly, from global and local spatial analysis it was found that children mortality rate in one district was directly affected by that of its neighbors. The results revealed that water closet, proportion of children under five, toilet availability, and mothers basic education attainment, vaccination coverage, size at birth, mother current working status, ORS information, altitude, stunting score and wasting score of children were significant determinants of children mortality rate. Thus, it is suggested that the geographically targeted preparation on accumulation of treatment that can be useful to control and stabilize spillover (nearest area spread) of disease such as diarrhea, malaria, and fever over space is recommended. It can be suggested for this states’ that the government needs to make intervention to mitigate the spatial variation of the prevalence across regions. Keywords: Child mortality, Spatial data Analysis, GEODA, EDHS, SNNPRS. DOI: 10.7176/JHMN/89-01 Publication date: May 31 st 2021

Under-5 Child Mortality Determinants in Rural-Urban Areas of Bangladesh: Proportional Hazard Models

The People’s Republic of Bangladesh is a South Asian country with a vast population. The early childhood mortality is a noticeable public health problem. The study work aims to determine the factors related to under-5 aged child mortality in both rural and urban areas of Bangladesh; data pulled out from BDHS (Bangladesh Demographic and Health Survey)-2014. In rural and urban areas, 5306 and 2454 less than five years aged children born before in 5 years preceding the survey respectively. The Kaplan-Meier log-rank test is applied to determine the risk factors in bivariate analysis to multivariate survival models. In multivariate analysis to find out the risk factors of under-five aged child mortality, the Cox proportional hazard model and the Cox frailty model were employed. Religion, father’s educational level, number of antenatal care visits, multiplicity of birth, child size at birth, place of delivery, total children ever born, number of living children are the significant factors of child mortality in rural, urban areas. The variability among children for mortality is 0.000529 and 0.001225 in rural and urban areas individually. Proper notable attention needed for significant determinants, which may increase child survival.

Child Mortality and Maternal, Neonatal and Child Health in Iraq in the Last Two Decades: Trends and a Way Toward the SDG Targets for Child Survival

Background: Iraq has experienced decades of devastating wars and conflicts, which profoundly affected health including higher child mortality during 1990s. We examined the recent trends for child mortality and maternal, neonatal, child health and family planning (MNCH-FP) services since early 2000s during which Iraq also experienced war, invasions and conflicts. Methods: We conducted in-depth secondary data analyses using Multiple Indicator Cluster Surveys from 2006, 2011, and 2018. We examined national and subnational rates and trends for neonatal and under-five child mortality and 27 MNCH-FP indicators at national, regional and governorate levels. We used Lives Saved Tool (LiST) to model the impact of expanding coverage for child mortality reduction. Findings: From 2006 to 2018, under-five child mortality (U5MR) dropped from 40.9 to 27.1 deaths per 1,000 livebirths; neonatal mortality (NMR) declined from 21.6 to 13.3 deaths per 1,000 livebirths, with overall annual rate reductions (ARR) of 3.4% and 4.1%, respectively. ARRs were greater in Kurdistan (U5MR: 8.3%; NMR: 10.6%) compared to South/Central region (U5MR: 2.7%; NMR: 3.2%). Child mortality increased during post-2003 war and ISIS invasion periods. Analysis of governorates shows heterogeneity with limited progress in several governorates. LiST modeling suggests that universal scale up of MNCH interventions by 2030 could reduce 39% of child deaths in Iraq. Interpretation: Despite wars, conflicts, and invasions, Iraq demonstrated significant resilience and is poised to reach SDG-3.1 goals in upcoming years. However, significant inequity persists by regions, governorates, and socioeconomic variables. Addressing this is critical to strategically accelerate child mortality reduction in Iraq. Funding: UNICEF Iraq Office through contributions from the Government of Canada and Czech Republic. Declaration of Interest: All authors declare no competing interests.

Multilevel Modelling of Under-Five Time to Death, and Risk Factors

Under-five mortality is a leading indicator of child health and overall development of a country. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday. Half of all under-five deaths in 2019 occurred in just five countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo, and Ethiopia. In Ethiopia, as the 2016 Ethiopia Demographic and Health Survey (EDHS) report showed that the under-five mortality declined from 166 deaths per 1,000 live births in 2000 to 67 deaths per 1,000 live births in 2019 mini EDHS report (60% decreasing rate). However, there are regional disparities problems on under-five children mortality in Ethiopia. Thus, the major purpose of this study was to model the multilevel effects of U5 child time to death, and to determine the risk factors for child’s death based on the last full report (2016 EDHS). The data were analysed using descriptive statistics, stratified Cox proportional hazards regression and multilevel parametric survival models. In the study, 635 (6.1%) U5 deaths have observed from 10,331 children. And, the overall probability of survival was 0.93. Results obtained by fitting both stratified Cox proportional hazards regression and lognormal parametric fixed-effect models: sex of child, type of birth, birth order, size (weight) of child at birth, months of breastfeeding, number of U5 and five children, family size, wealth index, frequency of listening radio, place of delivery place of residence, and geographical region were found to be significant factors for U5 children death or estimated mean survival time. Furthermore a high risk death of U5 children was found to be associated with male children, twined children, ≤ 6 months breastfeeding children, few number of children in the home, children from small family size, children average weight below, children from poor families, private health sectors delivered children, children from mothers didn’t not listen radio, children from rural areas, children from Afar, Somali and Harari regional states. In the lognormal parametric random effects model, 1.7 and 0.9 estimated variations were observed among regional and household cluster levels on U5 children mean survival times. The researchers recommended that governments, and other concerned bodies should give special supports for mothers whose children are at high risk of death.

Discontinuation of healthcare and factors associated to mortality among severe acute malnourished children under five years in healthcare and nutritional care settings.

Even if under-five children mortality tends to decrease considerably in developed countries, it remains a major concern in Sub-Saharan Africa. The purpose of the present study is to assess causes of healthcare discontinuation and factors associated with mortality among severe acute malnourished children under five years old in the health district of Gorom-Gorom in Burkina Faso. A descriptive retrospective study on healthcare discontinuation and deaths of severely acute malnourished children under five years old who registered from July to December 2018, in the health district of Gorom-Gorom in Burkina Faso. A total of 377 records of children suffering from severe acute malnutrition were exploited. Children of age range 6-23 months were the most predominantly malnourished. Healthcare discontinuation was observed at rates around 24.4%.Deaths were recorded in 9.72% of children hospitalized in the CRNE and around 1% in children in the ambulatory care management. The severe acute malnutrition co-morbidity factors included oral candidiasis [OR=14.8; (95%CI 1.128-194.285)], dehydration [OR=11.46; (95%CI 1.085-121.038)] and malaria [OR=8.32; (95%CI 1.915-36.191)]. The risk of death of severe acute malnourished children is higher when the disease is associated with complications.

Utilization of Integrated Community Case Management Service and Associated Factors Among Mothers/Caregivers Who Have Sick Eligible Children in Southern Ethiopia

BackgroundProper utilization of integrated community case management service has a significant contribution in reducing the under-five children mortality. However, the utilization of integrated community case management service is low especially in developing countries like Ethiopia. Therefore, this study was planned to assess the utilization of integrated community case management service and associated factors among mother/caregivers who have sick children aged 2–59 months in Boloso Sore Woreda, Southern Ethiopia.MethodsCommunity-based cross-sectional study design was done from January 15-February 15, 2018. Face to face interview was conducted using pre-tested structured questionnaire. Bivariable and multivariable logistic regression analysis were carried out to assess the association between independent and outcome variables. Odds ratio along with 95% confidence interval and p-value <0.05 were estimated to measure the strength of the association and statistical significance.ResultsThe magnitude of the utilization of integrated community case management service was 25.3%. Mothers/caregiver’s education of secondary and above (AOR=4.15, 95% CI: 1.94–8.90), mothers/caregivers having good knowledge about childhood illness (AOR=2.00, 95% CI: 1.08–3.69), the previous visit of mothers/caregivers to health post (AOR=2.92, 95% CI: 1.01–8.54), short distance to health post (AOR=2.42, 95% CI: 1.02–5.76), the child with cough (AOR=2.52, 95% CI: 1.13–5.63) and mother’s/caregiver’s perception of high severity of illness (AOR=2.51, 95% CI: 1.19–5.27) were significantly associated with utilization of integrated community case management service.ConclusionThe magnitude of the utilization of integrated community case management was low in the study area. Mother/caregiver’s education of secondary and above, having good knowledge of childhood illness, history of mother’s/caretaker’s visit to the health post, short distance to the health post, and perceived high severity of disease and presence of cough were factors significantly determining service utilization. Therefore, health education should be provided to mothers by Health Extension Workers, community leaders, and organizations.

Reducing the Burden of Anemia and Neural Tube Defects in Low- and Middle-Income Countries: An Analysis to Identify Countries with an Immediate Potential to Benefit from Large-Scale Mandatory Fortification of Wheat Flour and Rice.

Using a predetermined set of criteria, including burden of anemia and neural tube defects (NTDs) and an enabling environment for large-scale fortification, this paper identifies 18 low- and middle-income countries with the highest and most immediate potential for large-scale wheat flour and/or rice fortification in terms of health impact and economic benefit. Adequately fortified staples, delivered at estimated coverage rates in these countries, have the potential to avert 72.1 million cases of anemia among non-pregnant women of reproductive age; 51,636 live births associated with folic acid-preventable NTDs (i.e., spina bifida, anencephaly); and 46,378 child deaths associated with NTDs annually. This equates to a 34% reduction in the number of cases of anemia and 38% reduction in the number of NTDs in the 18 countries identified. An estimated 5.4 million disability-adjusted life years (DALYs) could be averted annually, and an economic value of 31.8 billion United States dollars (USD) generated from 1 year of fortification at scale in women and children beneficiaries. This paper presents a missed opportunity and warrants an urgent call to action for the countries identified to potentially avert a significant number of preventable birth defects, anemia, and under-five child mortality and move closer to achieving health equity by 2030 for the Sustainable Development Goals.

Bayesian zero-inflated regression model with application to under-five child mortality

Under-five mortality is defined as the likelihood of a child born alive to die between birth and fifth birthday. Mortality of under the age of five has been the most targets of public health policies and may be a common indicator of mortality levels. Thus, this study aimed to assess the under-five child mortality and modeling Bayesian zero-inflated regression model of the determinants of under-five child mortality. A community-based cross-sectional study was conducted using the 2016 Ethiopia Demographic and Health Survey data. The sample was stratified and selected in a two-stage cluster sampling design. The Bayesian analytic approach was applied to model the mixture arrangement inherent in zero-inflated count data by using the negative Binomial–logit hurdle model. About 71.09% of the mothers had not faced any under-five deaths in their lifetime while 28.91% of the women experienced the death of their under-five children and the data were found to have excess zeros. From Bayesian Negative Binomial—logit hurdle model it was found that twin (OR = 1.56; HPD CrI 1.23, 1.94), Primary and Secondary education (OR = 0.68; HPD CrI 0.59, 0.79), mother’s age at the first birth: 16–25 (OR = 0.83; HPD CrI 0.75, 0.92) and ≥ 26 (OR = 0.71; HPD CrI 0.52, 0.95), using contraceptive method (OR = 0.73; HPD CrI 0.64, 0.84) and antenatal visits during pregnancy (OR = 0.83; HPD CrI 0.75, 0.92) were statistically associated with the number of non-zero under-five deaths in Ethiopia. The finding from the Bayesian Negative Binomial–logit hurdle model is getting popular in data analysis than the Negative Binomial–logit hurdle model because the technique is more robust and precise. Furthermore, Using the Bayesian Negative Binomial–logit hurdle model helps in selecting the most significant factor: mother’s education, Mothers age, Birth order, type of birth, mother’s age at the first birth, using a contraceptive method, and antenatal visits during pregnancy were the most important determinants of under-five child mortality.

Determinants and Trends of Under-Five Child Mortality in Ethiopia: A Multi-level Logistic Modeling Approach

The burden of under-five mortality remains unevenly distributed. About 80 percent of under-five deaths occur in two regions, sub-Saharan Africa and South Asia. Ethiopia is among the six countries that account for half of the global under-five deaths. The aim of this study was to identify the significant socio-economic and demographic factors influencing under-five child mortality and evaluate the variation among the regional states of Ethiopia. In this study, the 2000, 2005, 2011 and 2016 EDHS data were used to describe the trend of under-five mortality in Ethiopia. The 2016 EDHS data have been used to analyze determinants and variation of under-five mortality by background characteristics. Single-level logistic regression and multilevel logistic regression models were used to identify the major risk factors of under-five mortality and regional variations in under-five child mortality in Ethiopia using the 2016 EDHS data. The results from single-level and multilevel logistic regression analyses showed that Sex of a child, Age of a child in month, Birth type, Birth order number, Number of Household size, Breastfeeding status, Educational level of mother’s, Place of residence and type of toilet facility had significant effects on under-five child mortality and there is variation of under-five child mortality from region to region. Conversely, preceding birth interval, wealth index Household, Source of drinking water and place of delivery were found insignificant. The results revealed variation of under-five child mortality from region to region. The multilevel logistic regression analysis result showed that the effects of breastfeeding varied across regions whereas the effects of other covariates on under-five child mortality remained fixed across regions.